Hand Hygiene Glossary

Alcohol-based hand rub: An alcohol-containing preparation designed for application to the hands to reduce the number of microorganisms on the hands. In the United States, such preparations usually contain 60 percent to 95 percent ethanol or isopropanol.

Antimicrobial soap: Soap (detergent) containing an antiseptic agent.

Antiseptic agent: Antiseptics are antimicrobial substances that are applied to the skin to reduce the number of microbial flora. Examples include alcohols, chlorhexidine, chlorine, hexachlorophene, iodophors, chloroxylenol (PCMX), quaternary ammonium compounds, and triclosan.

Antiseptic handwash: Washing hands with water and soap or other detergents containing an antiseptic agent.

Antiseptic hand rub: Applying an antiseptic hand rub product to all surfaces of the hands to reduce the number of microorganisms present.

APIC: Association of Professionals in Infection Control and Epidemiology

Bloodstream infection (BSI): A serious infection that occurs when bacteria from an infected site on the body invade the bloodstream. If bacteria continue to multiply without being stopped by antibiotics or the patient's immune system, there is a high risk of septic shock, a potentially life-threatening condition.

Central line: This is a flexible tube that's inserted near a patient’s heart or into one of the large blood vessels near the heart. A central line can be used to give fluids, antibiotics, medical treatments such as chemotherapy, and liquid food if a patient is unable to eat or digest food normally. If a central line is inserted incorrectly or not cared for properly, it can cause dangerous bloodstream infections. Central lines are also sometimes called central venous lines, central venous catheters and C-lines.

Central Line-Associated Bloodstream Infection (CLABSI): When a patient gets a bloodstream infection after having a central line put in (or, in the case of a newborn, an umbilical catheter is also a central line) and the bloodstream infection is not related to an infection in another part of the body it’s considered a CLABSI. According to the Centers for Disease Control and Prevention (CDC), an estimated 248,000 CLABSIs occur in U.S. hospitals each year. These bloodstream infections often lead to longer hospital stays, higher costs, and an increased risk of dying. CLABSIs can be prevented through proper insertion and care of the central line. Every time a patient gets an infection that meets the definition of a CLABSI, hospitals must report it to the National Healthcare Safety Network (NHSN), defined below.

Central line days: This is the total number of days a central line is in place for patients in surgical, intensive care, and certain other hospital units. The count is performed at the same time each day. Each patient with one or more central lines at the time the count is performed is counted as one central line day.
For example: Five patients on the first day of the month had one or more central lines in place. Similarly, five patients on day 2, two patients on day 3, five patients on day 4, three patients on day 5, four patients on day 6,; and four patients on day 7 had central lines in place. Adding the number of patients with central lines on days 1 - 7 we would have 5 + 5 + 2 + 5 + 3 + 4 + 4 = 28 central line days for the first week. The number of central line days for the month is simply the sum of the daily counts.

CLABSI Infection Rate: To get this rate, we divide the total number of central line-associated bloodstream infections by the number of central line days. That result is then multiplied by 1,000.

Cumulative effect: A progressive decrease in the numbers of microorganisms recovered following repeated applications of a test material.

The Central Line Utilization Ratio: This ratio comes from dividing the number of central line-days by the number of patient days.

Hand hygiene: A general term that applies to handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.

Hand hygiene compliance: Is a measurement of appropriate HH. It is defined when HH is considered necessary and is classified according to one of the “5 Moments” (see below). If the action is performed when there is no indication and it has no impact in terms of preventing microbial transmission, then it is not considered to be an act of HH compliance. The number of Moments constitutes the denominator for assessing HH compliance. The actual HH actions undertaken are compared to the number of Moments observed to calculate the rate of HH compliance. HH non-compliance is defined when there is an indication for HH (i.e. a “Moment”) and yet no HH was undertaken.

Hand hygiene moments: Moments are based on those defined by the WHO Guidelines on Hand Hygiene. A Moment is when there is a perceived or actual risk of pathogen transmission from one surface to another via the hands. HCWs’ hands will come in contact with many different types of surfaces while undertaking a succession of tasks. The 5 Moments for HH are:

Moment 1: Before touching a patient
Moment 2: Before a procedure
Moment 3: After a procedure or body fluid exposure risk
Moment 4: After touching a patient
Moment 5: After touching a patient’s surroundings

Infection control / prevention processes: These are routine measures to prevent infections that can be used in all healthcare settings. These steps or principles can be expanded to meet the needs of specialized types of hospitals. Some hospitals make the processes mandatory.
Examples include:

• Diligent hand cleaning
• Use of personal protective equipment such as gloves, gowns, and/or masks when caring for patients in selected situations to prevent the spread of infections.
• Use of an infection prevention checklist when putting in central lines. The list reminds healthcare workers to clean their hands thoroughly; clean the patient’s skin before insertion with the right type of soap; wear the recommended sterile gown, gloves and mask; and place sterile barriers around the insertion site, etc.
• Monitoring to ensure that staff are following the proper infection prevention procedures.

Infection Preventionists (IP): These health professionals have special training in infection prevention and monitoring.

Methicillin-resistant S. aureus (MRSA): A type of staphylococci bacteria that is resistant to the commonly prescribed antibiotic, methicillin. This can cause serious infections.

Microorganisms: Microscopic organisms such as bacteria and viruses, commonly known as germs, can cause infections in humans.

Multi-drug resistant pathogens: Bacteria that cause serious infections that are very difficult to treat due to the pathogens' resistance to many commonly-prescribed antibiotics.

Nosocomial infection: An infection acquired in a hospital or other healthcare setting.

Outcome Measure: A feature used to describe the effects of care on the health status of patients and populations (e.g. infection rate).

Persistent activity: Prolonged or extended antimicrobial activity that prevents or inhibits the proliferation or survival of microorganisms after product application. This may be demonstrated by sampling a site several minutes or hours after application and demonstrating bacterial antimicrobial effectiveness when compared to a baseline level. In the past, this property has also been called "residual activity". Both substantive and non-substantive active ingredients can show a persistent effect if they lower the number of bacteria significantly during the wash period.

Pneumonia: Infection of the lung. Pneumonia once was a common cause of death and killed one out of four victims. It is still a serious disease, especially in infants and the elderly, who are most vulnerable.

Resistant gram-negative rods: A type of bacteria that causes serious infections that are very difficult to treat due to the pathogen's resistance to many commonly prescribed antibiotics. They are a cause of illnesses such as pneumonia.

Staphylococci: A type of bacteria that causes what is commonly called a Staph infection. Potentially, the bacteria can cause a life-threatening illness should it infect a major organ. Many Staph infections respond to antibiotics' however, there are resistant strains emerging.

Surgical site infections(SSI): Defined by the location of the original contamination, surgical site infections can be caused by MRSA, VRE and other dangerous multi-drug resistant pathogens.

Urinary tract infections: A bacterial infection of the urinary tract, which can include the bladder and kidneys.

Vancomycin-resistant enterococci (VRE): Enterococci are a type of bacteria that cause, among other things, serious surgical site and urinary tract infections which are very difficult to treat due to the bacteria's resistance to many commonly-prescribed antibiotics.

Ventilator associated pneumonia (VAP): Patients who need mechanical help to breathe have a high risk of developing hospital-acquired pneumonia. Reporting for VAP will be phased in when a standardized definition is developed. A standardized definition will make sure that hospitals are reporting the exact same event and will allow comparison between hospitals.